American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New Crucial Literature: The Science You Need to Know

Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the Bulletin Brief editorial board.

Pair of JACS

The Recovery Benefits of Peer-to-Peer Coaching after Bile Duct Injury

Zhu A, Deng S, Greene B, Tsang M, Palter VN, Jayaraman S. Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury. J Am Coll Surg. June 7, 2021 [Epub ahead of print].

Bile duct injury during laparoscopic cholecystectomy is a major complication associated with significant mortality and morbidity. Available data have documented significant psychological damage to surgeons who have injured a bile duct. This report evaluated outcomes of a peer-to-peer coaching program designed to reinforce learning of operative techniques that reduce the risk of bile duct injury. 

One-on-one coaching sessions with an experienced hepatobiliary surgeon focused on debriefing the index case and teaching techniques to avoid bile duct injury using videos of actual cases. Coaches were available for follow-up conversations by telephone. Exit interviews were used to determine surgeon acceptance of coaching, perception of complications associated with laparoscopic cholecystectomy, and experiences during the coaching sessions. 

Surgeon participants felt that the coaching sessions were helpful in regaining confidence and well-being; participants valued the fact that coaches worked to develop a collegial and nonjudgmental relationship. Based on these data, focused coaching sessions have potential value in assisting learning and restoring surgeon self-confidence following a major complication. Missing from the analysis are data on long-term psychological effects (such as post-traumatic stress disorder) of the complication and expense of the coaching program. Additional studies will be necessary to quantify the effects of these factors. 

Recommendations for Wearing Head and Neck Coverings for Religious or Cultural Reasons in the OR and ICU

Abdelwahab R, Aden A, Bearden B, Sada A, Bostwick JM. Surgical Scrubbing and Attire in the Operating Room and ICU: A Multicultural Guide. J Am Coll Surg. May 13, 2021 [Epub ahead of print].

Spruce L. Update to the Association of periOperative Registered Nurses Guidelines for Religious Head Coverings. J Am Coll Surg. June 16, 2021 [Epub ahead of print].

The report by Abdelwahab and coauthors provided recommendations for managing surgical attire for health care professionals who wish to wear head and neck coverings for religious or cultural reasons during perioperative care and critical care activities. The authors pointed out that data were not available to quantify the risk for contamination of the surgical site due to shedding of bacteria from head and neck coverings versus exposed head and neck skin. They recommended that head attire be covered with standard bouffant head coverings. Neck attire can be covered by modifying available surgical gowns (reversing the gown to increase coverage of the neck). Additional research to quantify the risk of contamination is needed. 

In the update from the Association of periOperative Registered Nurses, Spruce noted that current guidelines promulgated by the Association permit wearing of tightly woven, low-linting head and neck coverings with loose ends tucked in without additional disposable coverings during perioperative care activities. As further data on surgical infection risk become available, additional modifications to guidelines may be necessary. 


Other Article

The Success of Per-Oral Endoscopic Myotomy (POEM) in Treating Achalasia

Campagna RAJ, Cirera A, Holmstrom AL, et al. Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia. Ann Surg. 2021;273(6):1135-1140.

Achalasia is a rare esophageal disorder with symptoms including dysphagia, chest pain, regurgitation, and weight loss. Tests of esophageal function such as endoscopy and high-resolution manometry usually show a non-relaxing lower esophageal sphincter and abnormal esophageal peristalsis. The most common surgical treatment for achalasia is laparoscopic Heller myotomy. An endoscopic myotomy procedure, per-oral endoscopic myotomy or POEM, was introduced in the early 2000s; short-term (two to four year) outcomes have shown symptom relief in 80 percent to 95 percent of patients. This report provided a summary of a single institution experience with 100 patients treated with POEM and followed for a mean of 55 months. Clinical success (relief of symptoms, improved esophageal function) was observed in 92 percent of patients; esophageal reflux symptoms were present in 33 percent of patients but were easily treated without surgical intervention. Five patients developed recurrent symptoms of achalasia and four of these were successfully treated with repeat POEM. The authors concluded that POEM was associated with long-term clinical success in most patients and that patients with recurrent symptoms can be easily treated with repeat POEM.